Doctor-Patient Communication in Emergency Departments: Hong Kong and Australia - Prof Diana Slade (Australian National University)
The quality of healthcare experienced by patients depends on many factors, but communication between healthcare practitioners on the one hand and between them and patients on the other has long been overlooked. However, recently, ineffectivecommunication has been recognized globally as a major cause of critical incidents in hospitals (Slade et al, 2015; Eggins and Slade, 2016); causing harm—and even death—to patients, triggering most patient complaints and significantly increasing a country’s healthcare costs. In this paper I will report on the findings of two parallel research projects analyzing and describing communication in hospital Emergency Departments—one across five Emergency Departments in Australia and the other in an Accident and Emergency Department in a major public hospital in Hong Kong. In both projects the interdisciplinary research used complementary methods derived from both quantitative and qualitative approaches, incorporating ethnography and discourse analysis, with questionnaire surveys, interviews with healthcare practitioners and management, and audio-recordings of patients’ journeysfrom triage to disposition. This paper will focus on one aspect of this research—that of the Doctor patient consultations, identifying the features of both successful and unsuccessful interactions. It will detail the results from the in-depth linguistic analyses on both the interpersonal and informational patterns in the spoken interactions, and relating what happens in the consultations to the contextual characteristics of Emergency Departments. The contextual characterisation will highlight the communicative complexity of EDs, with increasing linguistic and cultural diversity. This is particularly the case in HK were many communicative challenges arise from the use of spoken Chinese (both Cantonese and Mandarin) in doctor-patient consultations, code-mixing (Chinese and English) practitioner-practitioner communication and the use of English in all the medical records.
By looking at authentic transcripts of Dr/patient consultations across the two different contexts (HK and Australia), I hope to demonstrate that failure to attend to the patient’s interpersonal needs can result in inadequate (or delayed diagnoses), lack of compliance with treatment and patient dissatisafaction. I will present a framework we have developed to help local practitioners establish effective communication strategies. The framework divides these strategies into two broad categories – the first one relates to the way medical knowledge is communicated between doctors and patients, while the second relates to the way doctor-patient relationships are developed, aspects necessary to achieve effective patient-centred care.